Constructing A Bundle For Preventing Unplanned Extubation Of Endotracheal Intubation In ICU Adult Patients Based On MCDA

Objective1.Construct a bundle for preventing unplanned extubation of adult patients with endotracheal intubation in ICU Based on Multi-criteria decision analysis(MCDA),in the purpose of providing evidence-based methods for clinical nurses to prevent unplanned extubation of adult patients with tracheal intubation.2.Translate and test the reliability and validity of the Chinese version of the EVIDEM multi-criteria nursing decision making evaluation scale,in the purpose of comprehensively evaluating the overall value of nursing interventions and providing nurses references to make decisions rationally and scientifically.Methods1.Based on scientific evidence-based theory to proceed systematic literature search and rigorous quality evaluation,the evidence summary of prevention and management of unplanned extubation in ICU adult patients with endotracheal intubation has been developed,laying the foundation for the bundle’s elements.2.Based on the Brislin model,the EVIDEM framework has been translated,cross-culturally adapted,and tested for reliability and validity,obtaining a nursing decision-making tool suitable for Chinese culture,which lays the foundation for intervention evaluation criteria.3.Based on AHP,evaluation criterion weight distribution has been determined.4.Adopted MCDA to quantify the value of evidence to construct a bundle for preventing unplanned extubation of adult patients with endotracheal intubation in ICU.Results1.A total of 10 articles were included,including 4 guidelines,1 evidence summary,3systematic reviews,2 randomized controlled studys.35 evidences were extracted,consolidated and integrated into 14 best evidences in 2 dimensions,including organizational management level and clinical implementation level.2.The Chinese version of the EVIDEM multi-criteria nursing decision making evaluation scale has a total of 15 items.The exploratory factor analysis extracted 6common factors,which could explain 71.929% of the total variance.The Item-Content Validity Index(I-CVI)ranged from 0.833 to 1.0,and the Average Scale-Content Validity Index(S-CVI/Ave)was 0.978.The Cronbach’s α for the total scale was 0.808,and the Cronbach’s α for six dimensions ranged from 0.685 to0.803.The test-retest reliability coefficient was 0.802,and the test-retest reliability coefficient for six dimensions ranged from 0.705 to 0.790.The Chinese version of the EVIDEM multi-criteria nursing decision making evaluation scale has acceptable reliability and validity.3.The enthusiasm and authority of experts were high,with a positive coefficient of83.33% and an authoritative coefficient of 0.867.The weight distribution of 15 items in the EVIDEM multi-criteria nursing decision evaluation scale was 0.0183 ～ 0.1661,and the consistency ratio was 0.0248,which meant the consistency of each item was good.4.There were 5 nursing measures in the bundle which aims for preventing unplanned extubation of adult patients with endotracheal intubation in ICU,ranked according to the score:(1)Develop clinical standards for analgesia,sedation and delirium care;(2)Instruct adult patients in ICU to conduct early activities as much as possible;(3)Nursing staff can correctly use delirium,sedation,and pain assessment tools to evaluate patients;(4)Require the nursing staff to use delirium,sedation,and pain assessment tools to regularly evaluate patients;(5)Monitor tracheal catheter balloon pressure as required.Conclusions1.Based on evidence-based theory,the best evidence summary for prevention and management of unplanned extubation in ICU adult patients with endotracheal intubation has been formed.2.Based on the Brislin model,the EVIDEM framework has been translated,and the EVIDEM multi-criteria nursing decision-making evaluation scale has good reliability and validity.3.Based on MCDA,a bundle for preventing unplanned extubation of adult patients with endotracheal intubation in ICU has been conducted.